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General NPI Number Information
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NPI Number | 1134170905
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Entity Type | Individual
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Provider Name | JERRY LYNN PHILLIPS O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 03/01/2020
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Provider Practice Location Address
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Address Line | 2864 WILLAMETTE ST SUITE 600
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City | EUGENE
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State | OR
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Zip | 97405-3297
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Country | US
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Telephone | 541-689-2881
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Fax |
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Provider Business Mailing Address
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Address Line | 2423 PANORAMA DR
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City | EUGENE
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State | OR
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Zip | 97405-1481
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Country | US
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Telephone | 541-729-4778
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Fax | 541-484-7674
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2681 ATI
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License Number State | OR
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